Clinical-Grade Validation of an Autofluorescence Virtual Staining System with Human Experts and a Deep Learning System for Prostate Cancer

Abstract The tissue diagnosis of adenocarcinoma and intraductal carcinoma of the prostate (IDC-P) includes Gleason grading of tumor morphology on the hematoxylin and eosin (H&E) stain, and immunohistochemistry (IHC) markers on the PIN-4 stain (CK5/6, P63, AMACR). In this work, we create an automated system for producing both virtual H&E and PIN-4 IHC stains from unstained prostate tissue using a high-throughput multispectral fluorescence microscope and artificial intelligence & machine learning. We demonstrate that the virtual stainer models can produce high-quality images suitable for diagnosis by genitourinary pathologists. Specifically, we validate our system through extensive human review and computational analysis, using a previously-validated Gleason scoring model, and an expert panel, on a large dataset of test slides. This study extends our previous work on virtual staining from autofluorescence, demonstrates the clinical utility of this technology for prostate cancer, and exemplifies a rigorous standard of qualitative and quantitative evaluation for digital pathology.